血浆(1,3)-β-D-葡聚糖检测在诊断恶性血液病危重患者并发侵袭性真菌病中的应用价值

Clinical value of(1,3)-β-D-glucan assay for diagnosing invasive fungal disease in critically ill patients with hematological malignancies

目的探讨血浆(1,3)-β-D-葡聚糖(BDG)检测在早期诊断恶性血液病危重患者并发侵袭性真菌病(IFD)中的应用价值。方法选取新乡市第二人民医院2015年1月至2017年12月收治的235例恶性血液病患者为研究对象,检测所有患者的血浆BDG或血清半乳甘露聚糖(GM)水平,比较BDG检测法与传统检测法、GM检测法诊断恶性血液病危重患者并发IFD的敏感度、特异度、阳性预测值和阴性预测值。结果 BDG检测法的受试者工作特征曲线下面积为0.823,当血浆BDG水平以80 ng·L^(-1)为截点时,其诊断恶性血液病危重患者并发IFD的性能最佳。BDG(≥80 ng·L^(-1))诊断恶性血液病危重患者并发IFD的敏感度、特异度、阳性预测值、阴性预测值分别为92.11%、82.39%、71.43%、95.62%,传统诊断法诊断恶性血液病危重患者并发IFD的敏感度、特异度、阳性预测值、阴性预测值分别为64.29%、90.51%、82.89%、77.99%,GM检测法诊断恶性血液病危重并发IFD的敏感度、特异度、阳性预测值、阴性预测值分别为67.11%、94.34%、85.00%、85.71%。BDG(≥80 ng·L^(-1))诊断恶性血液病危重患者并发IFD的敏感度和阴性预测值高于传统诊断法和GM检测法(P<0.05)。BDG检测法诊断恶性血液病危重患者并发IFD,其从发热(>38.5℃)至确诊时间短于传统诊断法(P<0.05)。结论采用BDG检测法能够早期诊断恶性血液病危重症患者并发IFD,其敏感度和阴性预测值较高。

Objective To explore the clinical value of（1,3）-β-D-glucan（BDG） assay for diagnosing invasive fungal disease（IFD） in critically ill patients with hematological malignancies.Methods Two hundred and thirty-five patients of hematologic malignancies were selected in the Second People＇s Hospital of Xinxiang City from January 2015 to December 2017,and the plasma BDG and serum galactomannan（GM） were detected.The sensitivity,specificity,positive predictive value,negative predictive value of BDG detection were compared with traditional detection and GM detection.Results The area under the receiver operating characteristic curve of BDG was 0.823,when the cutoff level of BDG was 80 ng·L-1,the performance of it for diagnosing IFD in critically ill patients with hematological malignancies was the best.The sensitivity,specificity,positive predictive value,negative predictive value of BDG（≥80 ng·L-1） for diagnosing IFD in critically ill patients with hematological malignancies was 92.11%,82.39%,71.43% and 95.62%,respectively.The sensitivity,specificity,positive predictive value,negative predictive value of traditional detection was 64.29%,90.51%,82.89% and 77.99%,respectively.The sensitivity,specificity,positive predictive value,negative predictive value of GM detection was 67.11%,94.34%,85.00% and85.71%,respectively.The sensitivity and negative predictive value of BDG（≥80 ng·L-1） for diagnosing IFD in critically ill patients with hematological malignancies were higher than those of traditional detection and GM detection（P〈0.05）.The IFD in critically ill patients with hematological malignancies diagnosed by BDG detection method,the time from fever（38.5 ℃）to confirmation was shorter than that diagnosed by traditional detection（P〈0.05）.Conclusion The BDG detection method can early diagnose IFD in critically ill patients with hematological malignancies,and its sensitivity and negative predictive value are high.